22nd March 2004
A twenty-nine-year old man with sinusitis and psoriasis.
R: Tell me what is your problem?
P: Doctor, basically, this sinus is getting too frequent these days. Every two months I end up wasting three to four days with the sinus. It started long ago but now with this sinus I find it very difficult to get up in the morning. This full area (shows infra orbital area of both the cheeks) this part has such a tremendous amount of pressure; you feel the pressure inside. That is the main thing. When I get up in the morning I can cough up, or blow the nose. It comes out, but the problem remains. You feel groggy throughout the day. Secondly, I have developed these big time scales on the head that have moved down this way (finger scrolling near the ear to the chin),both sides, here and only this place, that’s all (shows infra orbital area both the sides and forehead). This is like a reddish kind of inflammation, which develops some scaly kind of thing.
R: Tell a bit more.
R: Tell about your sinus thing again, pressure and all.
P: Sinus – basically I don’t know how I picked it up. Mostly it’s from people if they have a small infection, cough or cold, I take it from them. I just can’t take ice in anything. Even if it’s melted in a soft drink, it starts the same day. Yet if I have a soft drink which is normally chilled, or water which was put in the fridge, then it is not much of a problem. That is one part. The first day it starts with irritation somewhere inside the throat and behind this (gestures showing the throat and nose) and when I first spit out in the morning there will be fine specks of blood. It stops later. On the second day it stops. It is whitish gray on the first day and feels little drier than otherwise. It slowly moves to yellowish, and if it stays, it goes to green and then, on its way out, it goes to a very clear fluid and cough comes only if it is there for a longer period of time. The pressure sometimes is a little too much, the ears get blocked and then you have to blow the nose. I mean, close the nose and blow it. Then the ears open up (gestures closing the nose) and sometimes you feel you should poke something and possibly the pressure will get relieved, or something like that.
This cold never goes. It is there throughout the year. Clearing of the throat, and blowing of the nose is an everyday thing. The ears have got pretty scratchy. I need to scratch them almost everyday, use the bud almost everyday. Not that there is anything else, but it’s very dry sometimes. Recently I have picked up this habit of having a paan (beetle leaf) after I have a drink. I think it stops me from getting infection. I don’t know.
About the sinus I think that’s about it. It gets a little frequent, it’s disturbing. I generally tend not to go into the water, and be a little careful about things. I have stopped eating guavas because I think guavas will give this; stopped eating grapes for the same reason.
I developed migraine when I was in the first or second year of college; its onset was when I was exposed to heat, when I was out in the sun. It used to stay for three days. It used to come with an aura. In the initial stages, if I would look at something, I would see patches of caramel something like this (pointing out to the wall color of the room). I wouldn’t see in those parts and then the headache would start. So I was told to take some tablet when you can’t see, so I would carry those tablets around. Then slowly it changed to a mercury kind of color, a silvery kind of color. Then it changed to looking like when you put oil on water, how seven colors can be seen. Then I was treated by a homeopath for about four or five months, then that problem didn’t recur. The migraine never recurred.
About the sinus, that should be it. During the days when it is worse, I don’t feel I can go to work. It’s not fever. It’s just that you feel drowsy, groggy the whole day.
In all that he mentioned, the experience of the sinus was ‘pressure.’
R: Tell about this pressure a little bit more, describe that pressure.
P: Okay. Even now I have it to a certain extent. It’s there throughout, but (pointing at the infra orbital area) it’s like this area feels heavy and something is trying to come out. You get the feeling that you want to poke a hole, or put a bullet into it, and it will come out or something like that (laughs and shows gesture of a gun), it’s getting a little too much here in these areas. Sometimes even in the eyeballs you feel a little pressure. It’s like, if I press like this (presses on the infra orbital area with the fingers) I feel a little better. If I press, it lightens up. It feels as if some bubble is building up. This area is like really heavy you know, that’s about it.
He describes ‘pressure’ a little further. It feels as if something is trying to come out.
R: Tell about this pressure little bit more, the sensation of the pressure like you said something trying to come, that pressure, just describe it.
P: It’s like something is stuffed. I can’t possibly describe how it is.
R: You are doing well so far. Just little bit more.
P: It’s like something is stuffed in (pushing the fist up and down). It’s like something trying to come up. I need to do something to get it out.
A further description, with a gesture.
R: Describe this something stuffed in.
P: I don’t know, I can’t.
R: Whatever you can say. The definition of stuffed in, how is that like?
P: Something is trying to break out (showing the infra orbital area). It’s like something inside there, trying to put that pressure out. When you push this thing back you feel that you are pushing back, giving some kind of pressure. So that relieves.
R: Tell about this a bit more, trying to come out, trying to break out…Describe that a little bit more.
P: In what way? I can’t…
Trying to break out is an action. This is a hint of a process.
R: Describe the sensation or the action of trying to come out or trying to break out. Only this much.
P: I sometimes feel I should be doing something about it. If I take steam or if I sit and press like this (shows pressing with the palms), I feel that it may come out. There is always that feeling that if this thing gets relief I will be fine. Someone told me that for sinus the only treatment is to burn a hole there. I had a septal correction done.
R: A little bit more about something trying to come out or trying to break out – only this much. You are doing very well. There is no problem. This is just a way of our inquiry, how we try to understand something
P: I feel that there is some infection or something there, which is dirty, which I need to push out (gesture of pushing something out). And then I think things will be fine. Generally, if there is a small boil with a little pus I tend to clean it, even if it is painful. I tend to clean it very clean. That’s what I feel needs to be thrown out.
There is energy with ‘push out.’ The process is described in different ways now – ‘come out,’ ‘push out,’ and ‘thrown out.’ These phrases are similar, though not exact. The sensation cannot be fully described by a single word or phrase. All the phrases have it.
R: See, you are using some words…break out, thrown out, come out. You are using that gesture. Show that action you are using – break out, throw out, come out.
P: (Shows the same gesture)
R: Describe this action.
R: Do it once again.
P: (repeats the gesture)
R: Yes, I want you to describe this. Whatever comes to you.
P: It’s like something that I don’t want; want to get rid of it. That’s what I mean by this
The action is related to the experience. We can get further into the sensation by focusing on the action and disconnecting from the context.
R: A little bit more about this action, forget about yourself what you want to do or don’t want to do. Just describe this action little bit more.
P: It’s like I have something in my hand and I don’t want it. I realize it’s unwanted, something harmful, so I just want to throw it out (gesture as if throwing something).
He has gone to the general.
R: When you say something harmful what comes to your mind?
P: Now when I was telling you, I thought I would say something hot, something hot that is burning my hands so I would throw it out (gesture as if throwing something) or drop it.
There is heat and throwing out. Hot is a sensation. When the delusion is described as an experience, it is sensation.
R: Describe this something hot and burning my hands, whatever comes to your mind.
P: The first thing that came to my mind was a vessel, which I thought wasn’t hot. I picked it up and throw it.
When you focus on the energy, all the sensations come out. I asked about this action and he speaks about something hot, something burning.
R: What is the experience in that?
P: It’s relief. I mean it’s hurting me, so throw it out.
R: A little bit more about this action. You are doing exceedingly well. Just a little bit more, just this action. Describe this. Not about you, more description of this action.
P: It’s a jerk. A jerky kind of action.
‘Jerky’ is a further description of the quality of the action.
R: A little bit more about this jerky.
P: It’s like a disowning kind of action, you don’t want a part of it so you throw it out or give it back.
R: Describe the action jerky little bit more.
P: In what terms, Doctor? I can’t.
R: Whatever comes to you, when you do like this?
P: I generally don’t do it.
R: No, now.
R: What comes to you?
P: It’s like I am pushing something out, throwing something out.
R: Describe the action a little more – pushing and throwing – forget yourself. Just describe pushing and throwing.
I want only the action. By focusing on it, he will describe the exact qualities of the sensation. We want the pure experience, not the delusion. And so we refine the understanding. It’s a question of skill. It’s like playing a game of chess.
P: It’s not a very good thing. It’s like a sudden jerky movement. If somebody else were involved in this, he wouldn’t like it very much; he will be shaken up. He will find it a very rude thing or he wouldn’t like it at all. It’s too aggressive or too rude an action; rude, as in to throw out; possibly fall on another person or something like that. It’s more of a very not-thought-out kind of thing, very impulsive.
R: Very good, a little bit more about not thought, impulsive, jerky, and sudden.
P: It’s something that I rarely do; actually, it’s like flinging to throw off, to dissociate with that particular item you are trying to throw off. I can’t think of anything else.
R: You are doing very well just describe whatever comes to you when you say sudden, jerky, aggressive, not thought of, impulsive, flinging.
P: It’s like I had expected a thing to be something, and picked it up. Now I find it is something totally different from what I had expected and that is why this kind of action. I expected it to be not very hot. I mean it looks fine. I just lift it but then I suddenly find it’s hot, so I throw it out (gesture)
R: A bit more about expected to be something and it is totally different, just this much whatever you said now.
“I had expected it to be something, but it is totally different.” Hot is not all that uncommon. But the idea that it seemed like something, and then wasn’t, is. It is strange and peculiar.
P: I have a pet theory about expectation and reality gap. You expect a certain thing to be something. Then you actually get into it and see what is the reality, and then you tend to benchmark it against what is expected. So your thinking or rationale is based on what is expected. You generally tend to pick up something or take something to yourself if you think it to be of a certain good value. But when you actually take it to yourself, when you actually get to practically do something with it, you realize that is not something you want, or this is not what you thought it would be. That’s when you push it out. I mean you don’t want to carry the extra baggage. I mean it is some belonging. Then it’s very much possible to push it out, that’s how it starts.
R: Tell about this little bit more, this expectation reality gap, this extra baggage, how you push it out?
P: I will try and give an example. I do a little bit of photography. So I picked up an excellent camera from Singapore, and it was the best thing I could pick up that time with whatever budget I had. I worked out whether it will work in India or not, then came back here. When I came back here, I found out it’s extremely difficult to develop the rolls, they were of a different kind. Then it became a baggage for me so I had to push it out at the first go. I had to sell it out at the first go, but nobody would buy it in this country. So I just try and sell it off. Even smaller things, say a shirt, if you do impulsive buying, you think it’s nice and you buy it, it’s a nice color. You don’t think at that point of time. You buy it, you go home, you wear it and somebody says, this is nothing great, it looks bad. Then you look at yourself and say it’s bad. So you just push it out and don’t use it. It would happen almost daily with a lot of things.
R: So what is the experience of having this extra baggage? Like you bought the camera and you found that the rolls were not…
P: Yeah, you basically feel lost, lost in the sense you feel you could have reasoned out better. You feel you have wasted money on something that you could have utilized in a better way. You feel like a fool. You basically feel like an idiot.
Where is the energy in what he said? ‘Impulsive’ is what is related to the ‘sudden’ and ‘jerky’ in the past. It is a synonym of what had happened before.
R: Tell a little bit about this impulsive.
P: Impulsive in the sense that it’s like a very momentary kind of concept. At that moment it is the right thing to do, but as an after thought, you would have not bought it or not done it. That’s the point of time when rational thought goes out of the window. Normally, you tend to have a very logical, step-by-step approach. I reason it out and I say, “Yes”, this is why I want it and this is the kind of money it costs, and yes, that is why I can buy it. It is that point of time when all this goes in the wind, you totally go out for something totally different. Impulsive is when there is no rationale, no logic behind whatever you are doing. At that moment it feels reasonable.
It happens a lot of times. Possibly while conversing with you today, I say today this is right. Then I go back and think. I mean in the heat of the moment of arguing with you I would say no, I feel this is right and then I would think later that possibly the doctor had something to say. And yes, if I look at it in a little different way I would say, what the doctor said makes more sense than what I had said, so I should have listened to the doctor. This kind of a thing, which happens in daily life.
This kind of a behavior in relationships is more with my close friends and family where I tend to be more impulsive. Whereas with people I am normally not very comfortable, my colleagues who have not yet broken through that barrier of friends, I am very considerate in terms of thinking about an idea they put across. I tend to give them their chance; their way, to push their idea to me. I wouldn’t do that with my family and friends, I just push through. So I am more impulsive with these people than people I am not very comfortable with.
So ‘impulsive’ in his case, when it goes down to a deeper level, is to ‘push through.’ Impulsive is a human-specific word, but it has energy. I ask about it and he says a lot of mind things. I wait for him to talk it out. All the while, I am thinking, where is ‘impulsive?’ I am waiting for ‘impulsive’ to be translated into an action. That is where we will get to the sensation.
R: When you say ‘push through’ what comes to your mind?
P: When I say ‘push through’ what comes in my mind is my point of view that I try to thrust sometimes on people, possibly my wife, my mom and rarely my dad.
He gives me a human example, so I will ask again. He will come back to it.
It is a bit like when a thief commits a murder, he has to visit the place again. A wily detective waits there for him.
The energy is in a word related to action, movement, or a sensory experience, which is non-human-specific. The sensory experience common to mind and body will be seen to be common between man and nature.
R: Just tell about ‘push through.’
P: Getting into a train in the morning, trying to make way to get down at the particular station. Trying to get down at a particular station, there’s a lot of rush.
R: Describe that experience a bit more.
P: It’s like you have lot of pressure from all sides and you want to make your way out of that. I mean, there are a lot of things around which are bringing a lot of pressure on you. You want to just get out of it, you want to burst out, you want to just be free. You know how you are in a hot congested place, like a train and it’s sweaty and really hot and once you get out and you are in the place you wanted to be, and it’s more breathable, more clean, more nice.
He has come back to the original sensation in the chief complaint – ‘pressure,’ and this time, there is a finer picture at the general level. He has a lot of pressure from all sides and wants to burst out.
R: Describe this a little bit more the pressure from all sides and you want to get out, burst out. Just this much.
P: There is some place where you want to go to…
He will give a situation again, and it won’t help to go there. We need him to focus on the experience.
R: Forget about you…
R: Just this pressure from all the sides and burst out, only this much.
P: Like a balloon or just put a pin and it comes out.
R: More, very good, whatever that comes to you.
P: Since I am sitting here, the first thing that comes to mind is, say, a pus-filled wound or something. Press it and get it out and clean it up. That’s about it.
R: A bit more about pressure from all sides and burst out.
P: (thinks for a while) you want me to describe the event or an example?
R: Whatever comes to you. Describe to me the sensation of pressure from all the sides and burst out.
P: If I have to imagine myself being in pressure and to me what is bursting out, would that be okay?
P: I generally associate pressure with a lot of heat, a sweaty kind of feeling, grimy, dirty, unclean kind of thing, a lot of noise or generally a very tense kind of feeling and then getting out of that, you feel cool, breathe, feeling nice, bright, fresh.
R: Describe heat, just the word heat.
R: Describe heat and burning a little bit more.
P: It’s unbearable, heat is like something is unbearable, it’s like something that makes you very uncomfortable. Burning is like heat going beyond (shows hands going away from each other) and hurting you. Burning is destroying whatever is there.
R: Describe this destroying.
P: It’s like raze something to ashes.
P: It’s like putting something to ashes.
R: Something to ashes?
P: Yeah. Burning and destroying, or just trash things, destroy or break things.
P: Break things down.
I want to know what is the action. A process is going on. I want him to describe the modus operandi of the break, which will describe the whole process. Describe the energy, the action, and the process of breaking.
P: Take something and hit it down. Something like that (check the hand gesture).
R: Hit it down?
P: Yeah, hit it, break it in pieces and destroy it.
R: A little bit more about heat, burning, unbearable and especially heat going beyond and you showed something with your hands.
P: What I meant by heat going beyond (shows hands closer to each other, then going away from each other in upward direction) is heat going to a point where it gets to burning.
R: Just describe this action that you are showing.
P: This? (taking the right hand away quickly in upward direction)
P: This I did in that context.
R: Forget that context in which you used it.
P: Something going up.
R: Something going up, describe that little bit more.
P: (does that action) this action is like go away, it’s like going up.
R: Describe going up a little bit more.
P: Going up, going up fast (gesture) and quick.
R: Describe going up fast and quick.
P: It’s like uncontrollably going up.
R: Describe that a little bit more, uncontrollably going up.
P: It’s going to get dangerous, that kind of a thing.
R: Describe that a bit more.
P: Possibly going to break out, come out.
R: Describe break out and come out.
P: In this case, what we talked about here, break out would be something terrible.
R: Describe that break out that is terrible.
P: It will be like, unbearable heat, which will destroy everything.
R: Describe that a little bit more.
P: If you are there, you don’t know what to do, you just go off.
R: What is that unbearable heat, destroying things around?
P: It’s like fire all around, it’s uncontrollable, there is no help and nobody is going to come and save you. I mean something like that.
R: Describe that scenario a little bit more.
P: It’s a very helpless situation. You are gone, can have no hope, it’s finished, I mean that’s it. You let it build so much that it’s gone beyond (hands gesture; one hand is steady, the other moves up and away). Check this hand gesture.
R: Describe this build up and gone beyond.
P: It’s like you knew it was going up you could have done something but you let it grow, let it build up, let it come up for some gain or something like that but then it reached beyond a point where there is no control. So now you find yourself in a soup (gesture same as above)
R: You find?
P: Yourself in a spot and you don’t know how to react to it (gesture same as above)
R: What are you showing like this (asking regarding the gesture)?
P: When I put it here it’s like…
R: No. Describe this gesture.
P: This I would use normally as let me tell you something…
R: Just describe the gesture.
P: It’s like I am trying to tell you something very interesting (repeating the gesture). Let me give you this or let me open out.
R: What is open out?
P: Open out is I am going to break some news, which is, or I am going to tell you some news, which I know you will find interesting.
This is dead centre. That is why it doesn’t go further.
R: Tell me what is build up and gone beyond?
P: Build is like pressure, which is building, and you let it build up for some gain or expect in to perform in a particular way. But it is not, and it is not good. You let it build up because you thought it will perform in a particular way. But it performs something else, so it’s gone beyond, beyond your control.
R: You just describe to me, build up and gone beyond.
P: Build up could be used in a very different way also, it could be used in the sense of something that you put your heart in to.
R: Forget about yourself. Just describe me build up and gone beyond, you are doing extremely well. There is no problem.
P: Build up, it’s like somebody put effort…
R: No forget somebody, just the word build up.
P: It’s pressure.
We don’t want the human, we want the sensation.
R: Describe this build up and pressure.
P: Build up stands to pressure.
R: Describe build up and pressure.
P: It is going out of control. As time goes by, it is getting more and more out of control that’s what is being built up.